Provider Publications

Welcome » May 17, 2024 4:58 AM

	Alerts
	Ascension Password Change: On May 8, 2024, a cyber security event disrupted clinical operations of the Ascension Healthcare Network. To ensure the security of protected health information on the ForwardHealth Portal, ForwardHealth will prompt all providers owned by Ascension to change their password. Providers not owned by Ascension will not be prompted to change their password. For instructions on changing your Portal password, refer to the ForwardHealth Provider Portal Account User Guide. Multi-factor authentication (MFA) is now required for the secure ForwardHealth Portal. Providers are encouraged to refer to the ForwardHealth Multi-Factor Authorization Instruction Sheet for help setting up MFA preferences. Providers may contact their Portal account administrator or call the ForwardHealth Portal Help Desk at 866-908-1363. Note: This is a project-specific announcement and is not related to the Change Healthcare disruption.

Nurse Practitioner Provider Publications

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Update Number	Update Topic and Release Date
2019
2019-12	Clarification of Telehealth Policy for Telestroke, 4/9/19
2019-11	SeniorCare Waiver Given Temporary Extension, 4/3/19
2019-10	Pharmacy Policy Changes for Adderall XR Effective May 1, 2019, 3/13/19
2019-04	SeniorCare Waiver Given Temporary Extension for 60 Days, 1/31/19
2019-03	Brand Name Metadate CD No Longer Available, 1/28/19
2018
2018-48	Policy Changes for Alpha Hydroxyprogesterone Caproate (17P) Compound and Makena Injections, 12/18/18
2018-47	January 2019 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/14/18
2018-45	SeniorCare Waiver Given Temporary Extension to January 31, 2019, 12/7/18
2018-44	Changes to Prior Authorization for Migraine Agents, CGRP Antagonists, 12/7/18
2018-42	ForwardHealth Interim Coverage of Select Drugs, Including High Cost Drugs, Orphan Drugs, and Drugs Approved Under an FDA Accelerated Approval Pathway, 12/3/18
2018-34	Pharmacy Policy Changes Effective September 21, 2018, 9/21/18
2018-24	Information for Eligible Professionals Regarding Program Year 2018 of the Wisconsin Medicaid EHR Incentive Program, 6/25/18
2018-22	July 2018 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/15/18
2018-20	Certification and Service Provision for Opioid Treatment Programs, 6/6/18
2018-19	Drug Coverage Limitations for SeniorCare Members, 6/4/18
2018-15	New Policy for Outpatient Behavioral Health Services, 4/26/18
2018-10	New Face-to-Face Visit Requirement and Changes to Policy for Home Health Services, Durable Medical Equipment, and Disposable Medical Supplies, 3/5/18
2017
2017-42	January 2018 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/15/17
2017-34	New and Clarified Pharmacy Policy and Claims Submission Requirements, 10/26/17
2017-32	Prior Authorization Required for Mavyret™ and Vosevi™, 10/6/17
2017-28	Changes to Coverage Policy and Prior Authorization Requirements for Behavioral Treatment, 9/5/17
2017-27	New Prior Authorization Policy for Outpatient Behavioral Health Services, 9/5/17
2017-26	New Policy and Procedure Codes for Certain Dental Services and Appliances 8/25/17
2017-25	New and Clarified Telehealth Policy, 8/18/17
2017-24	Cancellation of the Personal Care Independent Assessment Program, 7/31/17
2017-19	Information for Eligible Professionals Regarding Program Year 2017 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 6/19/17 October 2, 2017: Information under the "Clinical Quality Measure Reporting Periods" heading has been revised in response to the Hospital Inpatient Prospective Payment System final rule. The change is indicated in red text.
2017-17	July 2017 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/16/17 *June 21, 2017: This Update* has been revised with additional information since its original publication.** Information under Olysio^® as Combined with Sovaldi^® has been added in red text on page 17 of the Update.
2017-16	Prior Authorization Required for Spinraza™, 5/24/17
2017-11	New Personal Care Independent Assessment and Prior Authorization Policy, 4/6/17 July 31, 2017: The independent assessment and prior authorization policy outlined in this ForwardHealth Update is obsolete as of August 1, 2017. Please refer to the July 2017 Update (2017-24), titled "Cancellation of the Personal Care Independent Assessment Program," for more information or to the ForwardHealth Online Handbook for current personal care policy.
2017-07	Changes to Billing and Reimbursement Policy for Covered Outpatient Drugs, 3/15/17
2017-06	Coverage Policy for Facial Prosthetics, 3/1/17
2017-02	New Coverage Policy for Home Ventilator Rental, 1/26/17
2016
2016-54	January 2017 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/16/16 *March 6, 2017: This Update* has been revised since its original publication.** Information under the Clinical Criteria for Cytokine and CAM Antagonist Drugs for Crohn's Disease section has been added in red text on page 9 of the Update.
2016-48	ForwardHealth Coverage and Prior Authorization Policy for Personal Continuous Glucose Monitoring Devices and Accessories, 10/27/16
2016-45	Documentation Requirements for Evaluation and Management Procedure Codes, 10/19/16 November 7, 2016: This Update has been revised since its original publication. Page 2 lists examples of non-verifiable types of phrases for pre-loaded or pre-generated text. The change is indicated in red text.
2016-41	Information for Eligible Professionals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/5/16 January 4, 2017: Information under the "Electronic Health Record Reporting Periods" heading has been revised in response to the CMS Hospital Outpatient Prospective Payment System final rule. The change is indicated in red text. May 16, 2017: Federally Qualified Health Centers and Rural Health Clinics were added to the "To" list of providers.
2016-38	Targeted Reimbursement Rate Increase for Certain Dental Services Provided in Four Counties, 9/16/16 October 7, 2016: This Update has been revised since its original publication. The list of procedure codes in the Attachment on page 5 have been revised. Procedure codes D3221 and D7140 have been added and procedure codes D3220 and D7111 have been removed. The changes are indicated in red text
2016-34	New and Clarified Policy for the Behavioral Treatment Benefit, 8/3/16
2016-32	Revised Prior Authorization Forms and Changes to Pharmacy Policies for Hepatitis C Agents Effective August 1, 2016, 7/29/16
2016-30	Pharmacy Policy Changes Effective August 1, 2016, 7/18/16
2016-25	Information for Eligible Professionals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 6/24/16
2016-23	Reporting Other Health Insurance Information on Dental Claims, 6/24/16
2016-22	July 2016 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/17/16
2016-21	Prior Authorization Will No Longer Be Required for Crinone^® 8% When Used for Certain Indications, 6/7/16
2016-20	Prior Authorization Will No Longer Be Required for OnabotulinumtoxinA (Botox^®) When Used to Treat Chronic Migraines, 5/27/16
2016-19	Prior Authorization Required for Rosuvastatin Tablets, 5/24/16
2016-18	Date of Service Defined and Documentation Requirements Clarified for Durable Medical Equipment and Disposable Medical Supplies, 5/16/16
2016-16	Changes to Coverage Policy for Testing for Drugs of Abuse, 4/18/16
2016-15	Information for Eligible Professionals Regarding Changes to the Wisconsin Medicaid Electronic Health Record Incentive Program for Program Year 2015, 4/28/16 May 16, 2017: This Update has been revised since its original publication. Federally Qualified Health Centers and Rural Health Clinics were added to the "To" list of providers.
2016-14	Changes to Pharmacy Policies for Hepatitis C Agents, 4/13/16
2016-09	Prior Authorization Criteria and Coverage Policy for Prophylactic Mastectomies, 3/3/16
2016-08	Prior Authorization Criteria and Coverage Policy for Gynecomastia Surgery, 3/3/16
2016-06	Prior Authorization Required for Generic Imatinib Tablets, 2/1/16
2015
2015-63	SeniorCare Waiver Extended to December 31, 2018, 12/21/15
2015-62	New ForwardHealth Behavioral Treatment Benefit, 12/18/15 *December 28, 2015: This Update* had been revised since its original publication.** ForwardHealth has made minor revisions to pages 19 and 62. The changes are indicated in red text.
2015-61	January 2016 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/18/15
2015-59	Prior Authorization Requirements and Coverage Policy for Restorative Plastic Surgeries and Procedures, 11/25/15
2015-57	Prior Authorization Required for Paliperidone Tablets, 11/02/15
2015-55	Provider Enrollment for the New Behavioral Treatment Benefit, 10/27/15
2015-51	Clarification of the Completion Instructions for the Consent for Sterilization Form, 10/13/15
2015-50	Pharmacy Policy Changes Effective October 15, 2015, 10/5/15
2015-45	New Coverage and Prior Authorization Policy for Cranial Remolding Orthosis, 9/14/15
2015-43	New Prior Authorization Guidelines for Pectus Carinatum Surgery, 9/9/15
2015-41	New Policy Regarding Coverage and Prior Authorization Criteria for Hyperbaric Oxygen Therapy, 9/1/15
2015-34	Revised Prior Authorization Drug Attachment for Hepatitis C Agents Effective August 1, 2015, 7/22/15
2015-30	New Prior Authorization Approval Criteria for Reduction Mammoplasty, 7/2/15
2015-29	Drug-Related Supplies Reimbursed Fee-for-Service for Outpatient Pharmacies, 6/29/15
2015-27	July 2015 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/17/15 *February 23, 2016: This Update* has been revised since its original publication.** Information under the Clinical Criteria for Pediatric-Covered Indications for Growth Hormone Drugs section has been added in red text on page 10 of the Update.
2015-24	Information for Eligible Professionals Regarding Program Year 2015 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 6/8/15 January 27, 2016: The deadline for all Eligible Professionals to apply for Program Year 2015 Electronic Health Record incentive payments has been extended from March 31, 2016, to July 31, 2016.
2015-23	Coverage Policy for Sleep Medicine Testing, 6/4/15
2015-21	Additional Cellular/Tissue-Based Product Covered by ForwardHealth, 5/27/15
2015-13	Changes to Pharmacy Policies for Hepatitis C Agents Effective April 1, 2015, 3/18/15
2015-12	Changes to Coverage Policies for Permanent Implantation of Intrathecal Infusion Pumps for Treatment of Spasticity, 3/18/15
2015-09	Clarification Regarding Comprehensive Medication Review and Assessment Services for Members Recently Discharged from a Hospital or Long Term Care Setting, 3/6/15
2015-01	Affordable Care Act Primary Care Rate Increase Ended December 31, 2014, 1/5/15
2014
2014-79	Changes to Provider-Administered Drugs Carve-Out Policy, 12/16/14
2014-78	January 2015 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/18/14
2014-75	Procedure Code Changes for Influenza Vaccinations, 12/4/14
2014-74	Changes to Pharmacy Policies for Hepatitis C Agents Effective December 1, 2014, 11/19/14
2014-71	Changes for Program Year 2014 of the Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Professionals, 10/30/14
2014-63	Coverage Policy for Cellular/Tissue-Based Products, 10/10/14
2014-62	Changes to the 1500 Health Insurance Claim Form and Completion Instructions, 10/14/14
2014-59	Coverage of Services Rendered in Walk-In Retail or Convenient Care Clinics, 10/1/14
2014-55	Changes to Pharmacy Policies Effective October 1, 2014, 9/17/14
2014-55	Changes to Pharmacy Policies Effective October 1, 2014, 9/17/14
2014-53	Revised Prior Authorization Guidelines for Synagis^®, 9/15/14 *September 16, 2014: This Update* has been revised since its original publication.** Information under the Chronic Lung Disease of Prematurity section has been changed to clarify the gestational age at delivery is younger than 32 weeks. Revisions are indicated in red.
2014-49	Clarifications Regarding Coding Requirements for Intrathecal Pump Prior Authorizations, 9/4/14
2014-39	July 2014 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/20/14
2014-37	Coverage Policy for Emerging Molecular Pathology and Diagnostic Genetic Testing, 6/13/14
2014-26	New Prior Authorization Criteria for Intrathecal Infusion Pumps for Spasticity or Pain, 4/23/14
2014-22	Revision to Durable Medical Equipment Coverage, Policies, and Limitations, 4/30/14
2014-20	Policy Changes for Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections, 3/31/14
2014-16	Changes in How Nurse Practitioners and Nurses in Independent Practice Who Provide Respiratory Care Services Report Certain Training Information, 3/21/14
2014-13	Prior Authorization Required for Sovaldi^™, 3/3/14
2014-08	Changes to Pharmacy Policies Effective March 1, 2014, 2/17/14
2013
2013-67	January 2014 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/13/13
2013-54	Reimbursement for Services Provided Under the Affordable Care Act Primary Care Rate Increase, 10/14/13
2013-52	Information for Eligible Professionals Regarding Program Year 2014 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/7/13
2013-47	Additional Information and Clarifications Regarding Professional Claims for Compound and Noncompound Drugs, 9/26/13
2013-46	Changes to Pharmacy Policies Effective Fall 2013, 9/18/13 *September 19, 2013: This Update* has been revised since its original publication.** Information on page 4 regarding PA requests for Anti-obesity drugs and information on pages 6 through 8 regarding a prescriber's handwritten signature on the PA/DGA form have been revised. Revisions are indicated in red.
2013-44	Policy Clarifications for the Affordable Care Act Primary Care Rate Increase Provider Attestation, 9/5/13
2013-42	Policy Clarifications for OnabotulinumtoxinA (Botox^®) and Other Botulinum Toxins, 9/5/13
2013-41	Clarification for the Revised Prior Authorization/ Preferred Drug List (PA/PDL) Exemption Request Form and Completion Instructions, 8/20/13
2013-35	July 2013 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/20/13
2013-31	Requesting Exemption from Prior Authorization Requirements for Advanced Imaging Services, 6/3/13 *6/4/2013: This Update* has been revised since its original publication.** Information under the "Updating the List of Eligible Providers" heading has changed to reflect Portal solution changes.
2013-26	ForwardHealth Accepts the American Dental Association 2012 Claim Form, 4/17/13
2013-25	Affordable Care Act Primary Care Rate Increase Portal Attestation, 4/15/13
2013-21	Information for Program Year 2013 of the Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Professionals, 4/1/13
2013-20	Information and Policy Clarifications for the Medication Therapy Management Benefit, 3/26/13
2013-19	Services Reimbursable Only When Performed in an Inpatient Hospital or Ambulatory Surgery Center, 3/21/13
2013-15	2013 Procedure Code Changes for Dental Services, 3/12/13
2013-14	Policy for Onabotulinumtoxin A (Botox^®), 2/21/13
2013-05	Procedure Code Changes for Family Planning Only Services, 1/24/13
2013-02	New Modifier for Family Planning Only Services, 1/14/13
2013-01	Policy Clarification and Revised Claim Submission Instructions Regarding Maximum Daily Reimbursement Limits, 1/7/13
2012
2012-72	SeniorCare Extended to December 31, 2015, 12/27/12
2012-71	January 2013 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/21/12 *2/22/2013: This Update* has been revised since its original publication.** On page 8, the name of the preferred drug in the Cytokine and CAM antagonist drug class used to treat ulcerative colitis has been changed to Humira^®.
2012-67	Information for Eligible Professionals Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program, 12/17/12
2012-57	Enteral Nutrition Products Policy, 10/12/12
2012-54	Prior Authorization Policy for Lumizyme and Myozyme, 10/4/12 *November 15, 2012: This Update* has been revised since its original publication.** The process type has been revised in Element 2 of the prior authorization request form completion instructions on page 5. The change to the Update is indicated in red.
2012-46	Changes to Prospective Drug Utilization Review Alerts, 9/11/12
2012-39	Medication Therapy Management Benefit, 8/23/12
2012-35	New Prior Authorization Criteria for Vagus Nerve Stimulator Implant Surgeries, 7/25/12
2012-34	New Prior Authorization Criteria for Restorative Plastic Surgery and Procedures, 7/25/12
2012-25	Summer 2012 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/19/12
2012-23	Policy for Non-emergency Medical Transportation by Ambulance or Specialized Medical Vehicle Stretcher Van, 6/6/12
2012-18	Eligible Professionals Reporting Meaningful Use for the Wisconsin Medicaid Electronic Health Record Incentive Program and Other Program Information, 5/14/12 *This Update* has been revised since its original publication.** The Web page address on page 4 for core and menu set objectives has been revised.
2012-14	Change to Reimbursement for Consultation Services, 3/27/12
2012-13	Reimbursement Reduction to Professional Services Providers for Certain Services When Provided in a Hospital or Ambulatory Surgery Center, 3/27/12
2012-12	ForwardHealth Coverage of Computer-Based Testing of Student Athletes for Post-Concussion Syndrome, 3/23/12
2012-08	Procedure Code Changes for Family Planning Only Services, 3/21/12
2012-07	Spring 2012 Pharmacy Policy Changes, 3/9/12
2012-06	Wisconsin Medicaid Electronic Health Record Incentive Program Standard Deduction Information for Eligible Professionals, 2/20/12
2012-01	New Prior Authorization Policy for Antipsychotic Drugs for Children 6 Years of Age and Younger, 1/26/12 *This Update* has been revised since its original publication. The end date for the Attestation to Prescribe More Than One Antipsychotic Drug for a Member 16 Years of Age or Younger is for dates of process on and after February 15, 2012, not** for dates of service on and after February 14, 2011.
2011
2011-84	January 2012 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/20/11
2011-78	Clarification of Provider Responsibilities for Requesting and Amending Prior Authorizations for Synagis^®, 11/22/11
2011-72	Implementation of the HIPAA Accredited Standards Committee X12 Version 5010 Electronic 278 Health Care Services Review — Request for Review and Response Transaction, 11/7/11
2011-71	Prescription No Longer Required to Initiate Certain Mental Health and Substance Abuse Treatment Services, 11/4/11 *December 21, 2011: This Update* has been revised since its original publication.** The list of benefits that still require a prescription to initiate services has been revised as of December 21, 2011. Community Recovery Services do not require a prescription to initiate treatment. The change to the Update is indicated in red.
2011-69	Changes to Alpha Hydroxyprogesterone Caproate (17P) Compound Injection Policy and New Makena Injection Policy, 11/2/11 *This Update* has been revised since its original publication.** Effective for dates of service on and after January 1, 2012, procedure code J1725 is required on claims for alpha hydroxyprogesterone caproate (17P) compound injection and Makena injection. Refer to pages 2 and 4 of this Update for revised information.
2011-68	Additional Information and Clarifications Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/31/11 *This Update* has been revised since its original publication.** The November and December dates for an Eligible Hospital's fiscal year in Attachment 2 have changed since original publication. For more information, refer to page 7 of this Update or to the Determining the Payment Year for Eligible Hospitals topic (topic #12517) in the EHR Incentive Program section, Financial Information chapter of the Online Handbook.
2011-65	New Prior Authorization Criteria for Gynecomastia Surgery, 10/10/11
2011-64	New Prior Authorization Criteria for Pectus Excavatum/Carinatum Surgery, 10/10/11
2011-56	Changes to Pharmacy Policies Effective in October 2011, 9/21/11
2011-54	New Reimbursement Methodologies for Drugs and Diabetic Supplies, 9/20/11
2011-52	Revisions to 1500 Health Insurance Claim Form Instructions Resulting from HIPAA ASC X12 Version 5010 Implementation, 9/14/11
2011-50	Clarification of Sterilization Policy Regarding Retroactive Eligibility, 8/29/11
2011-49	Changes to Prior Authorization for Drugs and Diabetic Supplies Resulting from Implementation of the National Council for Prescription Drug Programs Telecommunication Standard, 8/31/11
2011-46	Policy for Provider Group Practice Certification, 8/24/11
2011-40	The Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Professionals, 7/25/11
2011-38	Wisconsin Chronic Disease Program Training Available, 7/25/11
2011-36	Summer 2011 Preferred Drug List Review, 7/11/11 August 8, 2011: A clarification has been made on page 9 to the clinical criteria for non-preferred orally disintegrating PPI tablets. July 15, 2011: An additional revision has been made on pages 6 and 7 as a result of the retroactive policy change. July 11, 2011: Retroactive for dates of service on and after July 1, 2011, simvastatin 80mg will remain a preferred drug. Page 7 of this Update has been revised to reflect the change in policy. The Preferred Drug List Quick Reference pharmacy data table was revised and posted to the ForwardHealth Portal on July 7, 2011, to reflect the change in policy. In addition, a change to the clinical criteria for proton pump inhibitor drugs was made on page 9.
2011-26	Changes to Newborn Reporting, 4/26/11 *On June 16, 2011, the Newborn Report (F-1165) has been revised since it was originally published in this ForwardHealth Update.* The revised form dated 06/11 is in the Attachment of this Update.
2011-23	Electronic Health Record Incentive Program Information Sessions Offered for Providers, Hospitals, and Staff, 4/11/11 The list of affected providers has been revised as of April 19, 2011. Advanced Practice Nurse Prescribers with Psychiatric Specialty, Dental Groups and Rural Health Clinics are eligible health care providers for this program and have been added to the Update. Optometrists were incorrectly listed as being eligible health care providers. All changes to the Update are indicated in red.
2011-22	Photographs Mailed to ForwardHealth as Additional Supporting Clinical Documentation for Prior Authorization Requests Will No Longer Be Returned to Providers, 4/11/11
2011-21	Changes to the Coverage of Active Pharmaceutical Ingredients and Excipients for Compound Drugs, 3/1/11
2011-20	Changes to Pharmacy Policies Effective in April 2011, 3/1/11
2011-13	Important Information About the National Correct Coding Initiative, 3/1/11
2011-10	New Laboratory Procedure Code Reimbursable for Tuberculosis-Related Services-Only Benefit, 2/1/11
2011-06	Three-Month Supply Drug Policy Changes, 1/1/11
2011-05	Changes to Newborn Reporting, 1/1/11
2011-04	Changes to the Pharmacy Services Lock-In Program, 1/1/11
2010
2010-121	Members 20 and Under May Elect Hospice and Continue with Active Treatment, 12/1/10
2010-120	New Procedure Code for Directly Observed Therapy for Tuberculosis Treatment, 12/1/10
2010-119	How to Correctly Indicate Modifiers on Claims for Repeat or Separately Identifiable Procedures, 12/1/10
2010-117	Over-the-Counter Drug Policy, 12/1/10
2010-116	Advanced Practice Nurse Prescribers with Psychiatric Specialty May Now Be Certified by Wisconsin Medicaid on the ForwardHealth Portal, 12/1/10
2010-115	Documentation Requirements and Changes to Prior Authorization and the Reimbursement Rate for Negative Pressure Wound Therapy Pumps, 12/1/10
2010-114	Changes for Master's-Level Psychotherapists, 12/1/10
2010-112	Opioid Monthly Prescription Fill Limit, 12/1/10
2010-108	Diabetic Supply Policy Changes, 12/1/10
2010-104	Changes to Coverage, Daily Rate, and Billing Instructions for Negative Pressure Wound Therapy Pumps for Nursing Homes, 12/1/10
2010-103	Changes to Pharmacy Policies Occurring in December 2010, 11/1/10
2010-101	New Reimbursement Rates for Certain Radiology Services Effective December 1, 2010, 11/1/10
2010-97	Clarification for Extraordinary Claims Submission for Professional Services, 11/1/10
2010-95	Changes to the Family Planning Waiver Effective November 2010, 11/1/10
2010-93	Limited Coverage of Screening Computed Tomographic Colonography, 10/1/10
2010-92	New Prior Authorization Requirements for Advanced Imaging Services, 10/1/10
2010-90	Reimbursement Reduction for Most Paper Claims Submitted to ForwardHealth, 10/1/10
2010-86	Prior Authorization Is Required for Avandia, Avandamet, and Avandaryl, 9/1/10
2010-85	Reimbursement Rate Increase for Pharmacy Providers for Therapeutic Interchange and Influenza Vaccine, 9/1/10
2010-84	Fall 2010 Preferred Drug List Changes, 9/1/10
2010-77	Changes to Assistant Surgeon Policy, 8/1/10
2010-74	Reminder of Deficit Reduction Act Policy for Prescribers, 8/1/10 *This Update* has been revised since its original publication.** Information about Provider Electronic Solutions software has been corrected. Refer to page 2 of the Update for more information.
2010-73	Reminders and More Information about Important Changes for Private Duty Nursing Providers, 8/1/10
2010-72	ClaimCheck Clarification, 8/1/10
2010-69	All HealthCheck Services Are Now Covered Under the BadgerCare Plus Benchmark Plan, 8/1/10
2010-57	July 2010 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/1/10
2010-56	Changes to Two Provider-Administered Drug Categories Related to Reproductive Health for Females, 6/1/10
2010-52	Pharmacy Services Covered Under the BadgerCare Plus Basic Plan, 6/1/10 *This Update* has been revised since its original publication.** The Explanation of Benefits code on page 5 has been revised.
2010-45	Ambulatory Surgery Center Services Covered Under the BadgerCare Plus Basic Plan, 6/1/10
2010-43	Coverage of Certain Medical Services Under the BadgerCare Plus Basic Plan, 6/1/10
2010-39	Coverage of Cervarix^® and Changes to the Coverage of Gardasil^®, 5/1/10
2010-36	Some Males Now Eligible for the Family Planning Waiver, 5/1/10 *This Update* has been revised since its original publication.** The URL to ACCESS has been corrected. See the correct URL indicated in red at the bottom of page 1.
2010-30	Changes for Diabetic Supplies, 4/1/10
2010-25	New Reimbursement Policies for Immunizations Given to BadgerCare Plus and Medicaid Members, 5/1/10
2010-23	Spring 2010 Preferred Drug List Review, 3/1/10
2010-21	Additional Comprehensive Examination Codes for BadgerCare Plus Core Plan, 3/1/10
2010-19	Change in Billing and Reimbursement for a Sterilization Procedure, 3/1/10
2010-15	Important Changes for Private Duty Nursing Providers, 3/1/10 *This Update* has been revised since its original publication.** The Private Duty Nursing Prior Authorization Acknowledgement form number on page 5 has been corrected.
2010-14	New Policies and Clarification of Certain Pharmacy Policies, 2/1/10 *This Update* has been revised since its original publication.** Revisions were made on page 2 of this ForwardHealth Update and are indicated in red.
2010-13	Clarification and New Policies for Drugs for Prescribers, 2/1/10 *This Update* has been revised since its original publication.** Revisions were made on page 2 of this ForwardHealth Update and are indicated in red.
2010-04	Quantity Limits for Certain Drugs, 2/1/10
2010-01	Preferred Drug List Changes, 1/1/10
2009
2009-98	Changes to the Three-Month Supply of Drugs Policy, 12/1/09
2009-95	Changes to Early Refill Prospective Drug Utilization Review, 12/1/09
2009-92	Additional Reimbursement for Reporting Body Mass Index for Children, 12/1/09
2009-89	Changes to Pharmacy Policies Occurring in January 2010, 12/1/09
2009-85	New Covered Health Education Benefit for Core Plan Members Diagnosed with Certain Chronic Conditions, 12/1/09
2009-78	SeniorCare Extended to December 31, 2012, 11/1/09
2009-77	Fall 2009 Preferred Drug List Review Phase II Changes, 11/1/09
2009-73	Overview of ForwardHealth Coverage of 2009 H1N1 and Seasonal Influenza Services, 10/1/09
2009-71	Revised Prior Authorization Drug Attachment for Synagis^® Form and Completion Instructions, 10/1/09
2009-63	Fall 2009 Preferred Drug List Review, 9/1/09
2009-58	New Reimbursement Rates for Certain Professional Services Effective October 1, 2009, 10/1/09 This Update has been revised since its original publication. Information for procedure code 27158 has been corrected. See page 5 of the Attachment for more information.
2009-56	New Modifier for Nonelective Cesarean Sections, 9/1/09
2009-53	Prior Authorization Procedures for Anti-Obesity Drugs, 9/1/09
2009-52	New Prior Authorization Criteria for Lovaza, 9/1/09
2009-49	Introducing the Drug Authorization and Policy Override Center and Prior Authorization Requirements for Synagis^®, 9/1/09
2009-44	New Location for Submitting the Wisconsin Well Woman Medicaid Determination Form and Form Revisions, 8/1/09 This Update has been revised since its original publication to include the full name of the Wisconsin Well Woman Medicaid Determination form, F-10075 (07/09), and to update the e-mail address for submitting the form.
2009-43	Revised Process for Family Planning Waiver Enrollment Applications, 8/1/09
2009-34	BadgerCare Plus Core Plan for Adults with No Dependent Children-Covered Pharmacy Services, 6/1/09
2009-28	ForwardHealth Announces Revisions to the Certification of Need for Specialized Medical Vehicle Transportation Form and Completion Instructions, 5/1/09 *This Update* has been revised since its original publication.** Elements 13 and 14 of the form are now optional. See Attachment 2 for a revised version of the form.
2009-25	Clarification of Policy and Reimbursement for Provider-Administered Drugs, 5/1/09
2009-22	Changes to Eligibility for the Continuously Eligible Newborn Option, 5/1/09
2009-20	Changes to the Newborn Report Form, 5/1/09
2009-19	Swine Flu Antiviral Drugs Are Temporarily Covered by the BadgerCare Plus Benchmark Plan and the BadgerCare Plus Core Plan, 5/1/09
2009-10	Spring 2009 Preferred Drug List Review, 3/1/09
2009-07	2009 CPT and HCPCS Procedure Code Changes for Physicians and Related Providers, 3/1/09
2008
2008-216	Provider-Administered Drugs for Members Enrolled in Managed Care Organizations Now Reimbursed by Fee-for-Service, 12/1/08
2008-209	Family Planning-Related Services Covered Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-202	Coverage of Certain Medical Services Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-198	BadgerCare Plus Core Plan for Childless Adults Training Available for Providers Who Serve Milwaukee General Assistance Medical Program Members, 11/1/08
2008-197	Enddating a Prior Authorization Request, 11/1/08
2008-196	New, Separate Dental Periodicity Table for HealthCheck, 11/1/08
2008-191	Coverage of Capillary Blood Draw, 11/1/08
2008-188	Risperdal Requires Brand Medically Necessary Prior Authorization, 10/1/08
2008-187	Correction to Prior Authorization Status Table, 10/1/08
2008-180	Fall 2008 Preferred Drug List Review, 9/1/08
2008-173	Changes to the Newborn Report Form, 9/1/08
2008-166	Changes to Reimbursement for Claims Submitted with the Health Professional Shortage Area-Enhanced Reimbursement Modifier, 9/1/08
2008-165	ForwardHealth Claims Submission and Reimbursement Policy for CPT Add-On Codes, 9/1/08
2008-159	1 Percent Reimbursement Rate Increase for Non-Institutional Services, 8/1/08
2008-150	Planned Effective Dates for Prior Authorization Changes for ForwardHealth interChange Implementation, 8/1/08
2008-143	Reminder: Tamper-Resistant Prescription Pad Requirement for Drug Prescriptions Effective October 1, 2008, 9/1/08
2008-141	Expanded Review by ClaimCheck, 8/1/08
2008-140	Correction to Guidelines for Reimbursement for On-Site Blood Lead Testing, 8/1/08
2008-126	National Drug Codes Required on Claims for Physician-Administered Drugs, 7/1/08
2008-122	HealthCheck Information Available Through the ForwardHealth Portal, 7/1/08
2008-111	ForwardHealth Announces Changes to Paper and Electronic Claims Submission for HealthCheck Providers, 7/1/08
2008-65	Changes to Prior Authorization for Physician Services, 6/1/08
2008-64	ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Physician Services, 6/1/08
2008-49	Changes to Prior Authorization for HealthCheck Services, 6/1/08
2008-40	Brand Medically Necessary Prior Authorization Requirements, 6/1/08
2008-29	Drug Coverage for Members Enrolled in the BadgerCare Plus Benchmark Plan, 4/1/08
2008-27	Guidelines for Reimbursement for On-Site Blood Lead Testing, 4/1/08
2008-26	Continuity of Care Transition Period for Pharmacy Services Ending for Managed Care Members, 3/1/08
2008-25	Spring 2008 Preferred Drug List Review, 3/1/08
2008-22	Reminder: Tamper-Resistant Prescription Pad Requirement Effective April 1, 2008, 3/1/08
2008-18	Limited Supply of Free Tamper-Resistant Prescription Pads Now Available, 2/1/08
2008-11	Procedure Code Changes for Physicians and Related Providers, 2/1/08
2008-07	Pharmacy Consolidation for Wisconsin Medicaid and BadgerCare Plus Managed Care Members, 1/1/08
2007
2007-112	Covered Services and Drugs for the Renewed Family Planning Waiver, 12/1/07
2007-99	Coverage of Certain Medical Services Under BadgerCare Plus, 12/1/07
2007-92	Home Health Services Under BadgerCare Plus, 11/1/07
2007-83	Family Planning Services Under BadgerCare Plus, 11/1/07
2007-82	Specialized Medical Vehicle Services Under BadgerCare Plus, 11/1/07
2007-77	Winter 2007 Preferred Drug List Review, 11/1/07
2007-74	New Place of Service Code, 11/1/07
2007-73	Clarification of Policy Regarding Consultations, 11/1/07
2007-71	Work Schedule Requirements Change for Private Duty Nursing, 10/1/07
2007-67	Tamper-Resistant Prescription Pad Requirement Delayed, 10/1/07
2007-66	Fall 2007 Preferred Drug List Review, 9/1/07
2007-65	Tamper-Resistant Prescription Pad Requirement, 9/1/07
2007-64	Diagnosis Code Restrictions and Quantity Limits for Altabax^™, Bactroban^®, and Mupirocin, 9/1/07
2007-43	Revised Prior Authorization / Preferred Drug List for Hypoglycemics for Adjunct Therapy Form, 6/1/07
2007-41	Guidelines for Certain Reproductive Health Services, 6/1/07
2007-36	Blood Lead Testing Requirements, 5/1/07
2007-31	Wisconsin Medicaid Expands 100-Day Supply Drug List, 3/1/07
2007-28	Spring 2007 Preferred Drug List Review, 3/1/07
2007-24	Changes to Immunization CPT Procedure Codes for the Vaccines for Children Program, 2/1/07
2007-14	Emergency Medication Dispensing, 2/1/07
2007-01	Covered Services and Drugs for the Family Planning Waiver, 1/1/07
2006
2006-100	Revised Criteria and Forms for the Prior Authorization / Preferred Drug List, 12/1/06
2006-95	New 1500 Health Insurance Claim Form and Supplemental Instructions, 12/1/06
2006-92	Changes Effective January 1, 2007, for Specialized Medical Vehicle Services Providers and Prescribers, 11/1/06
2006-89	Correction to Health Professional Shortage Areas and ZIP Codes, 11/1/06
2006-86	Fall 2006 Preferred Drug List Revision, 10/1/06
2006-85	100-Day Supply Drug Policy and Drug Utilization Review Alert, 10/1/06
2006-80	Temporomandibular Joint Evaluation Requirement Discontinued, 10/1/06
2006-76	Fall 2006 Preferred Drug List Review, 9/1/06
2006-72	Wisconsin Medicaid Allows Dose Consolidation and Tablet Splitting, 8/1/06
2006-70	Wisconsin Medicaid Adopting Documentation Guidelines for Evaluation and Management Visits, 8/1/06
2006-69	Primary Care Treatment and Follow-up Care for Mental Health and Substance Abuse, 8/1/06
2006-68	Facility Reimbursement for Sterilizations Provided to Family Planning Waiver Program Recipients, 8/1/06
2006-59	Health Professional Shortage Area Zip Code Changes, 6/1/06
2006-58	Wisconsin Medicaid Reimburses Selected Services Provided Through Telemedicine, 6/1/06
2006-53	Quantity Limits Apply to Triptans and Pharmaceutical Care Code Expansion, 6/1/06
2006-50	Atypical Antipsychotic Drug Class Added to Preferred Drug List and Prior Authorization/Preferred Drug List Forms Revised, 6/1/06
2006-33	Revised Preferred Drug List Information, 3/1/06
2006-32	Spring 2006 Preferred Drug List Review, 3/1/06
2006-29	Revised Prior Authorization Home Care Attachment and Plan of Care Requirements for Home Health and Private Duty Nursing Services, 3/1/06
2006-21	Separate Reimbursement Allowed for Emergency Evaluation and Management Services Performed with Surgery Services or Consultations, 3/1/06
2006-19	Modifier "CR" Accepted for Catastrophe/Disaster-Related Crossover Claims 3/1/06
2006-08	Nurses in Independent Practice Handbook Released, 2/1/06
2005
2005-66	Physician Services Handbook Revised, 11/1/05
2005-62	New Health Professional Shortage Area Modifier, 10/1/05
2005-60	Wisconsin Medicaid Enters Multi-State Preferred Drug List and Supplemental Rebate Program, 9/1/05
2005-58	"Medicaid Therapy Services for Children" Brochure Revised, 9/1/05
2005-57	Wisconsin Medicaid Issues Prior Authorization Home Care Attachment for Home Health and Private Duty Nursing Services, 9/1/05
2005-54	Reimbursement Changes for Provider-Administered Drug Codes, 9/1/05
2005-53	New Claim Submission Requirements for Synagis^® (palivizumab), 9/1/05
2005-46	Wisconsin Medicaid No Longer Reimbursing for Procedure Code 97010, 9/1/05
2005-44	Information About a New Class Added to the Preferred Drug List, 8/1/05
2005-32	Expanded Preferred Drug List Information for Prescribers, 6/1/05
2005-27	Change in Requirements for Retaining Certification to Provide Private-Duty Nursing Services After Certification to Provide Respiratory Care Expires, 5/1/05
2005-24	Expanded Brand Medically Necessary Prior Authorization Criteria, 4/1/05
2005-18	New Preferred Drug List Information for Prescribers, 3/1/05
2005-15	Vaccines for Children Program Resumes Coverage of Tetanus Vaccine, 3/1/05
2005-14	Registered Nurses Required to Use Modifier "U1" for Coordinating Services of Ventilator-Dependent Recipients, 3/1/05
2005-09	Additional Option for Submitting Prior Authorization Requests Via the Web, 1/1/05
2005-07	Procedure Code Updates, 1/1/05
2005-05	Wisconsin Medicaid Now Reimburses for Laboratory Procedure Code 0010T for Tuberculosis Blood Test, 1/1/05
2004
2004-92	Preferred Drug List Information for Prescribers, 12/1/04
2004-89	Wisconsin Medicaid Accepting Prior Authorization Requests Via the Medicaid Web Site for Additional Service Areas; Training Sessions in January and February 2005, 12/1/04
2004-81	Department of Health and Family Services Issues Emergency Order Regarding Influenza Vaccine for the 2004-2005 Season, 10/1/04
2004-77	Prescriber Information on the Wisconsin Medicaid Preferred Drug List, 9/1/04
2004-74	Prescribers Reminded of Policy for Drugs Dispensed in a 100-Day Supply, 9/1/04
2004-71	Wisconsin Medicaid Reimbursement of Influenza Vaccine for the 2004-2005 Season, 9/1/04
2004-66	Billing Requirements for Synagis^® (palivizumab), 8/1/04
2004-65	Training for New and Current Users of Provider Electronic Solutions (PES) Software Offered in September and October, 8/1/04
2004-64	Code Changes for End-Stage Renal Disease-Related Services, 8/1/04
2004-63	Prescriber Information on Prior Authorization Requirements for Brand Medically Necessary Drugs, 8/1/04
2004-53	Submitting Prior Authorization Requests Via the Web for Selected Services, 6/1/04
2004-51	Family Planning Waiver Recipients May Be Eligible for Wisconsin Well Woman Medicaid, 6/1/04
2004-47	Revision to CMS 1500 Claim Form Instructions for Clozapine Management Services, 6/1/04
2004-44	Annual SeniorCare Renewal Process Reminder, 6/1/04
2004-40	Training Sessions in July on Submitting Prior Authorization Requests Via the Web, 5/1/04
2004-35	Prior Authorization Request Submission Available Soon on the Web, 4/1/04
2004-28	Revised Certification of Emergency for Non-U.S. Citizens Form, 4/1/04
2004-27	Submitting Claims for Anesthesia Services, 4/1/04
2004-21	Health Professional Shortage Area changes, 3/1/04
2004-20	Family Planning Waiver program eligibility period and presumptive eligibility reminders, 3/1/04
2004-16	Prior authorization required for brand name selective serotonin reuptake inhibitor drugs, 3/1/04
2004-14	Wisconsin Medicaid coverage of topical application of fluoride for children, 2/1/04
2004-03	Procedure code updates, 2/1/04
2003
2003-137	Reminder that annual SeniorCare renewal process has started, 8/1/03
2003-119	Effective dates for claims submission and prior authorization changes as a result of HIPAA for physician services, 8/1/03
2003-98	Effective dates for code changes as a result of HIPAA for tuberculosis-related services, 8/1/03
2003-92	Effective dates for claims submission changes as a result of HIPAA for HealthCheck and HealthCheck outreach and case management services, 8/1/03
2003-89	Effective dates for claims submission changes as a result of HIPAA for clozapine management services, 8/1/03
2003-68	Family Planning Waiver Program policy additions and clarifications, 7/1/03
2003-61	Changes to local codes, paper claims, and prior authorization for physician services as a result of HIPAA, 7/1/03
2003-55	Changes to local codes and paper claims for HealthCheck and HealthCheck outreach and case management services as a result of HIPAA, 7/1/03
2003-48	Changes to local codes and paper claims for clozapine management services as a result of HIPAA, 7/1/03
2003-34	Changes to local codes for tuberculosis-related services as a result of HIPAA, 6/1/03
2003-19	Introducing the Guide to Determining Presumptive Eligibility for Pregnant Women, 3/1/03
2003-15	Revised form for specialized medical vehicle transportation services, 3/1/03
2003-10	Wisconsin Medicaid revises Newborn Report form, 2/1/03
2003-08	Wisconsin Medicaid introduces Guide to the Tuberculosis-Related Services Only Benefit, 2/1/03
2003-02	Wisconsin Medicaid revises Provider Certification of Emergency for Undocumented Aliens form, 1/1/03
2003-01	Wisconsin Medicaid revises prior authorization Physician Attachment (PA/PA), 1/1/03
2002
2002-69	HCPCS screening procedure codes policy, 12/1/02
2002-68	Introducing the Medicaid Family Planning Waiver benefit, 12/1/02
2002-58	Wisconsin Medicaid provides options for providers submitting claims for obstetric services, 10/1/02
2002-56	Procedure code updates, 10/1/02
2002-55	Revised policy requirements and procedure codes for breast pumps, 9/1/02
2002-53	Wisconsin Medicaid covers procedure code for Lunelle^™, 9/1/02
2002-47	Coverage revised for critical care and prolonged services, 8/1/02
2002-44	Coverage of Botox^® and Myobloc^®, 8/1/02
2002-40	Maximum allowable fee increases for physician services, 7/1/02
2002-19	Procedure codes eligible to receive the Health Personnel Shortage Area-enhanced reimbursement rates, 5/1/02
2002-17	Coverage of anti-emetic drugs, 5/1/02
2002-13	Maximum allowable fee and coverage changes for physician services, 3/1/02
2002-01	Medicaid reimbursement for required newborn screening, 1/1/02
2001
2001-41	Place of service for nurse practitioners performing home births, 12/1/01
2001-27	Updates to physician services coverage policies and limitations, 9/1/01
2001-25	Certification required for nurse practitioners who treat Medicaid recipients, 7/1/01
2001-24	Allowable Medicaid-covered procedure codes expanded for nurse practitioners, 7/1/01
2001-11	"Medicaid Therapy Services for Children" brochure available, 5/1/01
2001-02	Revision of breast pump coverage, 1/1/01
2001-01	Prospective Drug Utilization Review's impact on prescribers, 1/1/01
2000
2000-57	Change in occupational therapy prescription requirements, 11/1/00
2000-46	Immunization CPT code changes, 10/1/00
2000-20	One percent reimbursement increase for noninstitutional services — Effective July 1, 2000, 6/1/00
2000-14	Prior authorization no longer required for selected injection procedure codes, 5/1/00
1999
99-18	Change in prescription requirements for billing Medicaid, 4/1/99
99-17	Newborns: new Medicaid eligibility procedures and reporting requirements for hospitals, 4/1/99
99-13	Wisconsin Medicaid revises private duty nursing prior authorization guideline, 4/1/99
99-09	Wisconsin Medicaid revises quantity limitations for supplies for Type II diabetics, 3/1/99
99-05	Correction to Medicaid�s definition of Type II diabetes for purposes of Medicaid coverage, 2/1/99
1998
98-33	Wisconsin Medicaid adopts Medicare's diabetic equipment and supplies policy, 12/1/98
98-29	SMV transportation physician certification form revised, 10/1/98
98-22	Billing Nurse Practitioner and Midwife Services: Allowable Procedure Codes, 06/29/98
98-17	Two percent reimbursement increase for noninstitutional services, 5/28/98
98-09	Physician office counseling visits and 1995 Wisconsin Act 309, 3/2/98
98-01	Lead poisoning: number one environmental threat to Wisconsin children's health, 1/2/98
1997
97-44	Clozapine and clozapine management changes, 12/12/97
97-41	Medicaid abortion policy, 12/5/97
97-40	Biennial Budget Increases Reimbursement for Noninstitutional Services — Effective July 1, 1997, 12/3/97
97-39	Coverage of stereotactic computer assisted intracranial procedures, 12/3/97
97-20	Infant head molding bands, 6/20/97
97-08	New diagnosis code for mother/baby claims, 2/18/97
97-04	Revised Administrative Rules: Medically Unnecessary Services — Effective March 1, 1997, 01/30/97
1996
96-46	Varicella virus vaccine (Varivax), 12/4/96
96-33	CLIA waived tests, 10/15/96
96-05	Implantable contraceptive capsules: removal with reinsertion, 3/14/95
96-04	Rhogam injection added, 3/14/96
96-03	New tuberculosis (TB) benefit, 3/12/96
1995
95-47	IUDs: reimbursement policy and rate changes, 11/20/95
95-16	Transportation policy changes affect referring providers, 5/26/95
95-14	Contraceptive products, 5/22/95
95-8	New health professional shortage areas (HPSAs), 3/21/95
95-4	Enhanced procedure code review during claims processing, 10/1/91

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